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Email address *
Camper's Name (Last, First) *
Your answer
Which week(s) will your child be attending camp? *
What grade is the camper entering in the 2020-2021 school year? *
Which school did the camper attend in 2019-20? *
List the names/grades of any friends or siblings with whom the camper would like to be placed on a team.
Your answer
T-shirt size *
Parent / Guardian's Name: *
Your answer
Parent/Guardian's phone number: *
Your answer
Please indicate your payment method: *
If paying via PayPal, please list the email and name associated with your PayPal account.
Your answer
Do you give your child permission to swim (kids will be supervised by both camp AND pool staff)? *
Only the following individuals are permitted to pick my child up from camp: *
Your answer
I understand that Sandlot is a sports/activities camp, which means that there is a small potential for injury. I hereby waive any right to sue Sandlot Worthington or any of its employees in the event of a personal injury to my child. *
CONSENT TO TREATMENT: In the event that reasonable attempts to contact the above-mentioned have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary for the well-being of my child. *
If you have a preferred physician or dentist, please list names and phone numbers.
Your answer
Please describe any allergies or special health concerns:
Your answer
Will you be leaving any medications or equipment with the camp staff (EpiPens, inhalers, medications, etc.)? If so, please list and provide dosage information.
Your answer
My camper is currently insured under a health/medical insurance plan offered by the following insurance provider: *
Your answer
Do you give permission for your child to be photographed / images of your child to be posted on our website/Facebook page? *
How did you hear about Sandlot Camp? *
A copy of your responses will be emailed to the address you provided.
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